Transcript: How to Prevent Kidney Stones with Diet

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

This is what the surface of a kidney stone looks like under a microscope. Imagine that scraping down your urinary canal. Kidney stones affect approximately 1 in 11 people in the United States, though 20 years ago it was only 1 in 20, a dramatic increase in the prevalence of this disease, which started going up after World War II. Our first clue as to why was published in the 70s; a striking relationship was found between stone incidence and the consumption of animal protein. But this was a population study, though—you can’t prove cause and effect. So next, researchers in Britain did an interventional study, added animal protein to their diet, like an extra can of tuna fish to their daily diet, and measured stone-forming risk factors in their urine: how much calcium they were peeing out, the concentration of oxalate and uric acid in their urine before, and after, the extra tuna. Their overall probability of forming stones increased 250% during those days they were eating that extra fish. And that so-called high animal protein diet? That was just enough to bring intake up to that of the average American. So the average American intake of meat appears to markedly increase risk of kidney stones.

So what about no meat? Well even by the late 70s, we knew that the only dietary factor consistently associated with kidney stones was animal protein. And not just getting your first kidney stone. The higher the intake of animal protein, the more likely an individual is to have multiple stones, rather than just a single stone episode. Not protein in general, it seems, but specifically high in animal protein. Conversely, a diet low in animal protein may reduce the overall probability of forming stones to become very low indeed, which may explain the apparent low incidence of stones in vegetarian societies. So, it may be worthwhile advocating a more vegetarian form of diet as a means of reducing the risk.

But it wasn’t until 2014 when actual vegetarians were studied in detail. Using hospital admissions data, they found that vegetarians were indeed at a lower risk of being hospitalized for kidney stones compared to those who ate meat, and among meat-eaters, increasing meat intake is associated with a higher risk of developing kidney stones, whereas a high intake of fresh fruit, fiber, and magnesium may reduce the risk. We can use this information to advise the public about prevention of kidney stone formation.

What advice should we give in terms of which animal protein is the worst? Despite compelling evidence that excessive animal protein consumption enhances the risk of stone formation, the effect of different sources of animal protein had not been explored until this study was published in 2014. People who form kidney stones are commonly advised to restrict the intake of red meat to decrease stone risk, but what about chicken and fish? We didn’t know until now. Salmon and cod were compared to chicken breast meat, and burger and steak. They found that gram for gram, fish may actually be worse in terms of uric acid production. However, the overall effects were complex. Basically, stone formers should be counseled to limit the intake of all animal proteins, and not just a little bit. Only those who markedly decrease their animal protein intake may expect to benefit from dietary recommendations.

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How much protein can I eat to reduce proteinuria? I am type 2 diabetic.

FruitedDragon

Just keep it plant-based and eat enough calories to have the energy you want everything just works itself out. Plants contain the perfect blend of protein, carbs and fats – optimal nutrition for humans

Joseph Gonzales R.D.

I am not sure if there is range of protein specific for proteinuria. I think the main goal is to control blood sugars and avoid the complications of diabetes to the best extent possible. Doing that can mean changing diet, lifestyle, and looking into medications that your doctor feels are right. if you don’t need medication than even better. The typical protein recommendations are 0.8 grams per kilogram of body weight. This can vary based on many factors so I don’t want to give an exact amount. A certified diabetes educator (CDE) could really help create an individual plan. If seeing a CDE is not an option, check out some of our resources on type 2 diabetes and share with your doctor to find a diet right for you. I have seen how diet can dramatically lower blood sugars in type 2 diabetics, and also help those who are overweight lose weight. From the research I was a part of with Dr. Barnard, study participants received either a low-fat vegan diet or a typical diet for diabetes and found significant changes in weight loss and insulin levels. Dr. Greger presents the study in this video. The protein consumed in this dietary intervention was on the low end, maybe 50-60 grams of protein per day. Rather than focus on protein I suggest thinking about food low in the glycemic index (berries, oats, barely, beans, vegetables), and a varied diet with tons of plant foods, herbs and spices!

Coolcat

Thanks I have a fasting glucose of 140 to 155 every morning. I am normal weight of 165 lbs at 9 feet tall. I was diagnosed at BG of 552, but got it down to 120 in 3 months. Now it is going up again. I try to keep my carbs down, and take a lot of vitamins. I stopped taking Metformen brcause of the side effets of diareaha and raised liver ensymes. I am taking no medications at all. I do not excercise, and that may be my main problem.

Joseph Gonzales R.D.

9 feet tall?! Please tell me typo ;-)

Keep up the good work. Talk to your doctor about supplements, and yes any type of movement is a good thing, don’t think of it as “exercise” just get out there and move to whatever you like to do. Seems like a dramatic lowering of BG! If you want any more suggestions, books, recipes, etc let us know!

Coolcat

I meant 5’9″. sorry.

Joseph Gonzales R.D.

10-4. Dang, you were almost recruited for the NutritionFacts basketball team ;-) Best to you!

Coolcat

lol. Thanks Doc.

Zuppkko

Why would you try to keep your carbs down (unless they are refined sugars..)? People have good results treating both types of diabetes and most of other dis-eases with high carb, low fat and low protein diets. Just take small steps and control results and try to gradually rebuild kidneys. But the lower the protein intake the better. Higher protein intake increases the risk of kidney failure and that is not the only risk increased protein intake will bring (nuts and seeds also included). Lack of protein is possible only if you starve. And even regular fasting is showing great health results for most of the people. So dont worry, eat whole carbs and eat kidney rebuilders (fresh juicy fruits, melons, berries, parsley, tomatoes, …) as much as you can.

Coolcat

If I want blood sugar to spike, I’ll eat all of the above. Thanks for your concern, but my glucose meter reads differently. My blood glucose on very low carbs this morning was 168. It should be below 110.

Zuppkko

I just want to make sure you know that carbs from whole foods are not the reason why one gets diabetes. I wish you get well soon.

Coolcat

Thanks. I haven’t eaten refined carbs and sugar for years. I think my blood sugar problems are that I am to sedentary, and lazy to exercise. Plus the dawn effect of my fasting blood sugar is caused by my liver dumping glucose into my bloodstream as a method of waking me up in the morning.

Julie

My dad had a major operation for kidney stones 35 years ago, but thankfully hasn’t had one since. Come to think of it, he did reduce his animal protein intake about 3 years after the operation; maybe that’s what has prevented further stone formation.

Julot Julott

More like certainly. :D

guest

I’ve heard mineral waters high in calcium might be an issue. True?

Joseph Gonzales R.D.

Calcium can bind to oxalates and form calcium-oxalate stones – a very common form of kidney stone. Never heard of water being a concern. Water is apparently one of the best things to help reduce stone formation. Dr. Greger touches on this here and on oxalates here.

Dr. Gonzales, it appears the first link in the paragraph above, is broken, and the page reads “Error 404: Page not found.”

Joseph Gonzales R.D.

Fixed ! Sorry about that.

Rush

Nice video!
Is it really that some types of water has some effect on kidney stone formation?

Joseph Gonzales R.D.

Yes. Please see below I had to double check. It seems mineral water can affect stone formation, but not in a negative way. One study did find “the risk of uric acid precipitation also decreased significantly under bicarbonate water intake. However, an increase of the risk of calcium phosphate stone formation was observed in patients with multiepisodic CaOx-urolithiasis” however they conclude that bicarbonate water can be recommended for helping calcium oxalate and uric acid urinary stones. Another study on mineral water found positive results and changes in pH, however the level of urinary oxalate excretion did not go down. It may have something to do with diet. Water in general seems to be helpful rather than harmful. Hope these sources help! Thanks for watching the video.

Alice

This video doesn’t say a word about oxalates, the intake of which can be hugely increased with a vegetarian or vegan diet that has too many of the wrong vegetables. Want to all but guarantee a kidney stone? Have a spinach smoothie every day. Too many people switch to a veggie diet and find themselves with a stone because they inadvertently began to emphasize high-oxalate vegetables.

1. what poses the greatest risk of developing a kidney stone; animal protein intake or vegetables high in oxalates?

2. And does the consumption of vegetable foods rich in oxalates increase the risk of forming kidney stones when the individual regularly consumes or has regularly consumed in the past animal protein?

Doug Overman

Is it high-oxalate vegetables AND animal protein? I believe I got my kidney stones by not eating high-oxalate vegetables, but by eating a lot of animal products.

Alice

I was a vegetarian for 25 years and had switched the emphasis to fewer grains and more of what I thought of as healthy “super veggies” like sweet potatoes. I ended up with severe hyperoxaluria and a 7mm stone.

Doug Overman

By vegetarian do you mean you also ate dairy or fish?

Alice

Vegetarians don’t eat fish. Occasional dairy. But by not eating enough high calcium foods I had no calcium to bind with the oxalates in my gut so they could be eliminated rather than absorbed…I may have been better off with some regular dairy. Part of my treatment has been calcium citrate supplements. I would rather get nutrients from food but I was unable to maintain daily dairy…it upsets my stomach.

Wade Patton

There are lots of ways to be _unhealthy_ as a “vegetarian”. More details are necessary for us to make any sense out of what you were eating.

Alice

Wade, it was a whole foods diet with virtually no manufactured ingestibles. To give you some idea, breakfast was (and still is) a bowl of homemade vegetable soup. I am the last person who needs a lecture on healthy vs. unhealthy vegetarianism.

Wade Patton

No lecture intended, I only ask for clarification as it is impossible to know what other persons are thinking. Was only trying to help. So many folks drift into this forum fresh and new and are just beginning to unlearn what society and corporations have beaten into their heads. As pointed out by Dr. Greger in a youtube video (WRT the untimely death of a long-time vegan) and also by Dr. Pam Popper: The data pool for veganism is polluted by those who are vegan for ethical reasons rather than health. Hope you never have another stone. Namaste.

Lifematters

Ouch! Please don’t use the word “polluted” in the same sentence as those of us who are ethical vegans wade.. :-/ I know what you’re inferring but that’s a pretty offensive way of putting it, though I hope you don’t mean it like it appears here. Vegans are Vegans. Ethics are intrinsically bound to that term. Veganism is not a diet.
Vegans who are only interested in their own health are plant based.

Wade Patton

Okay, no problem. Thanks for helping me learn, I didn’t/don’t mean to be offensive.

Wade Patton

I edited to maybe a less offensive way of putting it? Please review. Thanks for helping me be somewhat less offensive. Not always easy, but never intentional.

Alice

I think the bottom line for me is that a person can be eating what appears to be a stellar diet and still have a 7mm stone that takes two surgeries to dig out. I was, for instance, eating a sweet potato every day which hugely increased my oxalate intake.

Alan

Again – I eat lots of sweet potatoes and have never had a problem with stones. Some days i may eat 2 or 3. Some days none. But from harvest to early spring when i usually run out of the ones a grow i eat plenty. And some after that, that i get from the store.

guest

Yes, hopefully this is the focus. Most of the community here is already vegan, and plant based. I’d like to see the focus on what plant foods are the biggest offenders for us, as a causative factor in kidney stone formation. I already abstain from the meat, and most here do as well, but I and others often liberally eat high oxalate fruits and greens and beens, and other plant foods. Please, Dr. G, spend more time on this. We (most of us) are already free of the meat.

Greg

My own doctor mentioned nothing about cutting back on animal protein after my last bout with kidney stones. Rather, I was given a list of high oxylate foods to avoid or limit, most of which are typically considered healthy vegetarian staples such as: most nuts, many beans and greens, sweet potatoes, soy, and so on. These lists can be found by doing a quick internet search for high (or low) oxylate foods.
I also would like to hear from Dr. Gregor about what a plant-based diet designed to limit kidney stone formation would look like. This would likely also be applicable to other kidney health issues as it seems that many usually healthy plant-based choices are restricted when dealing with kidney problems.

Joseph Gonzales R.D.

HI Greg. I posted a lot of information in this thread (as well as Dr. Greger himself) that may help. Please see our comments above and click the links for Dr. Greger’s videos about oxalates.

FruitedDragon

Jump on Twitter, @fruiteddragon. I’ve posted a diet plan that I eat – based on studying Dr. G’s videos for a year. It contains the HEALTHIEST and most life-promoting foods.

Agreed! Please see more of my comments, and Dr. Greger’s in this thread. Lots of info!

Mindy

I thought my vegan diet of 30 years betrayed me when I developed a calcium
oxalate stone 2 years ago. With the help of Jack Norris, RD.(link below), I
learned that vegans don’t get stones any more so than the general public.
Further investigation with Jack revealed that my gut may be devoid of a
particular good bacteria (oxalobacter formigenes) that most people have in their
guts to eat up oxalates; therefore, when I ate extremely high oxalate foods such
as spinach, quinoa, chocolate, sweet potatoes, etc., my body formed a stone. I
was enlightened when I read a study (link below) at Wake Forest University which
found that overuse of certain antibiotics wiped out ox form. When I was a
teenager, I was put on tetracycline for 4 consecutive years, and tetracycline is
one of the antibiotics cited. Unfortunately, there is currently no probiotic on
the market that simulates ox form. although as noted in Jack’s article (link
below), one is in process. I joined a (free) yahoo group called Trying Low
Oxalates (link below) which tested oxalate levels in over 1600 foods. It was a
huge adjustment for me to eat both vegan and low oxalate, and I lost 8 lbs. the
first month (I now eat vegan-moderate oxalates). But I was determined 1) to
remain vegan, and 2) to never get another stone. I increased my
water/fluids intake to 2 quarts/day, which is a challenge. Lemon juice, as
mentioned by others, is a stone-buster as is OJ (link below), but I prefer not
to have the added sugar. Below are some excellent references that were, and
continue to be life-savers for me, including a link to joining the Trying Low Oxalate group which will enable you to access the most up-to-date food oxalate list, and access to their facebook..

Mindy: It sounds like you totally figured it out for yourself and were still able to remain true to your values. I think this post will help a lot of people. Great post. Thanks!

robert

Hello Alice: Watching the video, I was wondering the same thing. I had kidney stones about 20 years ago soon after I stopped consuming milk products and, to replace the missing calcium, foolishly started taking calcium supplements in the form of calcium carbonate. Later I switched to calcium citrate and haven’t had any stones since. Anyway, I see conflicting information regarding the effect of oxalates naturally occurring in plant foods. I’ve seen reports saying that they have no effect on kidney stones; others say that they contribute to kidney stones. Perhaps this is a good topic for Dr. Greger to address in a future video. Are dietary oxalates a significant risk factor in kidney stone formation?

Joseph Gonzales R.D.

Hi, Robert. Luckily Dr. Greger came out of the woodworks and posted a great study above about oxalates in veggies and the risk of acquiring kidney stones. I added links to his videos above, and below about water and oxalates. See if they are helpful? Thanks for posting this I think it is such an important topic.

Reassuringly, a recent study found there was no increased risk of stone formation with higher vegetable intake. In fact, greater intake of fruits and vegetables was associated with a reduced risk independent of other known risk factors, meaning that there may be additional benefits to bulking up on plant foods above and beyond restricting animal foods. [Sorensen MD, Hsi RS, Chi T, et al. Dietary intake of fiber, fruit and vegetables decreases the risk of incident kidney stones in women: a Women’s Health Initiative report. J Urol. 2014;192(6):1694-9.]

I was lucky enough to be able to track my progress via Litholink testing and was able to see the dramatic results of dietary changes within the vegetarian category. I went from a 24 hour urine oxalate level of 101 to 29 by making different vegetarian food choices. I think that there are indeed other risk factors such as the health of the oxalobacter formigenes population in the gut, but there isn’t a good way at this time for people to have that information.

Joseph Gonzales R.D.

Thanks Alice. Further down on this thread I commented about oxalates. I’ll put them here, too.

Dr. Greger touches on this here and on oxalates here. I also suggest checking out the study that Dr. Greger posted. It seems oxalates are not the only concern and there are many ways to consume plenty of veggies without putting ourselves at risk for a kidney stone. If stone formation is common, Dr. Greger recommends seeing your physician to rule out a variety of hereditary and acquired diseases that can cause up to 20% of calcium-based stones.

masac

We changed our morning smoothie from Kale to spinach years ago after following the Fat Sick Nearly Dead Mean Green recipe for several months, several years ago. I kept adding more spinach believing it to be more healthful, but noticed what appeared to be rust in the toilet bowl every day. We reduced the amount of spinach in our diet but still consume it daily. The ‘rust’ went away but have wondered ever since what it was. After reading comments…are we doomed?

Darryl

Only 0.6 to 2.4% of the oxalate in spinach is absorbed, and most calcium oxalate in kidney stones is believed to arise from metabolism of glycine, hydroxyproline, glycolate, hydroxyproline, and vitamin C. Glycine and hydroxyproline are higher in animal proteins (especially collagen), while glycolate and vitamin C are high in some plant foods, but especially (for vitamin C) in vitamin megadosing. See (especially the discussion): Taylor & Curhan 2007. Oxalate intake and the risk for nephrolithiasis.

Wade Patton

I had spinach smoothies every day for ~6 months or longer. And was eating meat with regularity in those days and lots of fish. So, no it’s not a rule. 48 years Omnivore, never a stone. Now 95%+WFPB, feeling pretty good about my odds of ever experiencing the spiny devils.

Alan

I used to eat spinach everyday. And some days lots of it. I never had a kidney problem or stones at anytime. I do not eat near as much spinach now as i sort of got tired of it after eating so much for so long. But again i never had a problem. I have read that a person is more likely to have problems with foods high in oxalate acid if they cook them, which i very rarely did. I liked my spinach raw and still do when i do have it.

Doug Overman

I had a bout of kidney stones about 7 years ago (passing one stone), but annual x-rays still showed 5 4-6 mm stones in each kidney. I went WFPB about two years ago. Last year the doctor said I only had one 3 mm stone. I believe they were dissolved as I certainly would have noticed if I passed them.

I wish you could talk to my wife. She eats LOADS of animal products, ESPECIALLY fish, and she had an operation to remove an incredibly painful bunch of stones from her left kidney. Everything in this video matches what I’ve experienced firsthand from her.

I’m WFPB now, but she won’t give up her animal product-heavy diet. You’d think kidney stone pain would be enough to convince anybody, but unfortunately that’s not the case.

Plantstrongdoc M.D.

I would have guessed that during a pain attack from kidney stone was the right time to convince a person to become vegan – because that really hurts! Your wife must really love her steaks…..

Ed

Well, I’ve been WFPB for two years now, but when she had her kidney stones, I didn’t know any of the things I know now, and I was an omnivore along with her. If only I knew then what I know now.

Joe Caner

Have there been any study data regarding sodium intake on the formation of kidney stone formation?
One could imagine that increased sodium intake potentially increase the urine concentration leading to a higher likelihood of stone crystallization.

Joe Caner

I answered my own question. Check out the following video. It’s pretty interesting. Who would have thought that there were five (5) categories of kidney stones:
How Do Kidney Stones Form? How Can We Prevent Them? https://www.youtube.com/watch?v=kd1OgaoHkNk

Joseph Gonzales R.D.

You are good at that! :-) FYI Dr. Greger does address cutting back on sodium in his post, here. Thanks Joe Caner.

Joe Caner

Thank you Joseph. Since I have stopped using salt, I have become very sensitive to it. It just amazes me how much salt individuals and eateries will pore over food. On Saturday, a friend of mine who was brought up in south India took me out to an Indian restaurant, and ordered the food. He ordered some street dishes, and as I watched them make the stuff, I saw them poring on various sauces and powders onto the food. I saw the girl the counter dip a white plastic spoon into a bowl of something while and sprinkle a heaping teaspoon of the stuff on one of the dishes. I asked if that was salt which my friend confirmed. I should have declined to eat the food, but I figured I would graciously go along. That turned out to be a mistake. It was tasty enough, but later that evening I had a metallic taste in my mouth and I felt knocked out so I decided to go on a water fast to purge the excess a sodium out of my system. I feel much better now, but I am going to fast another day because I still don’t quite right.

How this ties into today’s subject is that my Indian friend gets kidney stones. I am going to refer him to this posting.

Michael Weisensee

I have been eating plant-based since Sept. 1990. I passed one in early 2013 a couple of months after surgery. Never had one before or since. I truly believe it was a side-effect of anesthesia. Anyone else have a similar story?

Alicia Townsend

Fellow vegans will love this…. I became severely dehydrated 2 summers ago after a week of protesting and leafleting in the Texas heat. I developed kidney stones due to dehydration. An omnivore friend kept insisting it was because I was eating too much protein. I’m pretty sure that’s the first time in the history of the world that a vegan was accused of consuming too much protein! Haha

Joseph Gonzales R.D.

Hydration is key! Thanks for sharing your story, Alicia.

Kidney stones?

I have been vegan for over 2 years and I have developed kidney stones. I am eating lots of raw fruits and veggies with spinach daily (since I am allergic to lettuce), and a small amount of nuts. How can I develop kidney stones as a vegan? Now that I have them, how do I dissolve them out naturally with diet? I did not have kidney stones prior to being vegan.

Kidney Stones?

Also, I drink lots of water daily about 3 liters of water a day.

Ed

I’ve read that spinach is very high in oxalates… maybe you are particularly sensitive to oxalates.

Also, I’ve seen some claims that drinking lemon juice (sounds pretty tough to me), can help dissolve kidney stones over time. My wife said drinking freshly squeezed lemon juice every morning, followed by water, seemed to help. Best of luck!

I was not eating much meat at all, and rarely dairy or eggs, for years – more than seven years – but found I out I had huge stones – many of them – and had to have surgery. For the past several years I had been under extreme job stress, with months of too little sleep and too little exercise, as well as tremendous emotional stress from working in a somewhat abusive, hostile job situation while my husband was also deployed in Afghanistan and my kids were 2000 miles away. I have seen one study linking stress and kidney stones. Since the surgery I have continued to avoid animal products as well as high-oxalates like spinach, and sleeping more, husband is back, refuse to allow the work situation to cause me insomnia anymore, etc…I will be retested for hypercalciuria soon, but I already feel “things” in my left kidney again…

Debra

One of the citations listed in the 2014 article is from 2001 and it is a similar crossover study substituting animal protein for plant protein and it did NOT show any difference in the excreted markers for stone formation. Anyone able to see what’s wrong with that study? Thanks.

Joseph Gonzales R.D.

I did see something similar from a 2001 study, but not sure the exact one you mention. Feel free to always post a study! I think you bring up a good point. Perhaps that is why looking at a review of the evidence here may be more pertinent. Animal protein has purines and increases uric acid excretion. This review concludes reducing animal protein intake may help, pointing out “the mainstay of therapy is weight loss and urinary alkalinization provided by a more vegetarian diet.” Therefore I feel Dr. Greger is on the right track promoting a more plant-based diet for preventing kidney stones based on the available research.

Debra

a patient told me about her brother, who was plant based/vegan, but still had terrible kidney stones. I was wondering if he might also have been taking calcium suupplements thinking they were necessary.
My biggest question at the moment is about plain non fat yogurt. So many patients are asking if even this amount of dairy is dangerous. I’m really unsure…the casein might be changed by the fermentation; the amount of saturated fat is almost none. I tell folks, if they need to have some animal products still, perhaps this is the least worrisome in terms of health. Do you know of any data about plain non fat yogurt?
I know the data on casein from Campbell, but I heard even him state that the fermentation changes the protein, and may make it less carcinogenic.
Thanks,

Joseph Gonzales R.D.

Perhaps? I think it’s about quantity. For example, the Harvard School of Public Health talks about obtaining calcium from mainly beans and greens, and to limit milk and dairy products for various reason, including increase prostate cancer and to a lesser extent, ovarian cancer risk. They do not say avoid. Other research helps us identify substances like casein, as you mentioned Dr. Campbell’s work, and how based on this research it seems casein may not be the best choice of protein. Dairy and milk are not necessary in the human diet, but obtaining the nutrients found in these products is important albeit very easy. One potential advantage to avoiding the yogurt is that all dairy products have lactose, which will contain galactose (the sugar found in milk that may be harmful). Dr. Greger mentions the role of galactose in his video Is Milk Good for Our Bones? Yogurt may have a bit less galactose, but it is still there. Milk seems to be the most destructive of the dairy foods, but yogurt and other dairy products like cheese (although the research is mixed), have been associated with increased risk of insulin-like growth factor, which can boost other disease risks.

Lolly Pop

I had two episodes of kidney stones, now over 11 years ago. Both times my stones formed in the summer time, and I was not drinking enough water, plus I had started taking tums for the calcium content. Found out after that the calcium carbonate is a huge factor in stone formation. I now drink half my body weight in ounces of purified water daily (with some lemon, just a squirt, or one slice fresh lemon included), and haven’t have another stone since. Never use tums any more, and I avoid calcium carbonate, including carbonated water drinks, and calcium supplements. I eat meat, all kinds. However, I probably eat a normal amount of meat for my size. I eat nuts, and berries and and everything else that will grow. I have for almost a year now gone off of wheat, rye and barley. But, for 10 years previous I also ate all grains, as a regular diet. Everyone in my family has stones. One brother has lost a kidney to stones. My sister has stones under her tongue, in her kidneys and had so many stone in her gallbladder that it was removed over 20 years ago. Both of them consume soft drinks daily, and they also drink sweet tea. I gave up soft drinks 8 years ago, along with sweet tea and all other drinks with sugar. I drink water, herbal teas, and nut milks, and occasionally raw milk. Many of my friends have regular stone attacks and the common theme among them is they refuse to drink water. One glass of water is considered a lot to them.

Joseph Gonzales R.D.

Yikes! Thanks for sharing. I am glad you found something that works for you. I hope you can get the family some relief, as well.

As a dental hygienist, I have been telling patients this since 1984. That would be *30 YEARS*! YES, additionally, the higher animal protein intake also directly affects tartar buildup on your teeth. I see a direct correlation every day at work. Actually, it’s the high phosphorus content that is the culprit. ATP is a powerhouse of energy, but most people don’t need as much as they eat. http://www.brushforlife.com/fish-has-a-face/

Jody

I am sorry for the off-topic comment, but I noticed that the FAQs said all questions that were not covered on NutritionFacts could be posted on any topic. I have been diagnosed with SIBO and am following a low FODMAP diet with decent results. I am being told over and over again that I need to cut out grains and start eating bone broth and eat in order to heal. As I am a plant-based eater, I am sincerely hoping that this is not the case. I am already gluten-free, dairy-free, refined sugar free, and am on day 30 of an elimination diet (no alcohol, corn, caffeine, in addition to gluten, dairy, and sugar). I can’t seem to find any information about actually eradicating SIBO and doing so while not eating meat. I have tried Rifaxamin and it did nothing for me. Is there a vegan elemental diet? Any advice, information, book/website recommendations would be greatly, greatly appreciated. Thank you for all you do! I love this website.

Joseph Gonzales R.D.

No apologies necessary you are right, off topic comments are encouraged! Small intestinal bacteria overgrowth (SIBO) may be linked to a lactase deficiency. Celiac disease can make SIBO worse. Some research suggestsmalabsorbed fat may increase SIBO in subjects with tropical sprue (TS), which “is a common cause of malabsorption syndrome among adults in tropical countries including India1. TS is diagnosed by specific criteria, which include biochemical tests showing malabsorption of two unrelated substances, abnormal duodenal histology, absence of other causes of malabsorption and persistent response to antibiotics and folate2,3. Pathogenesis of this disease is unknown. Bacterial infection has been proposed to cause this syndrome in view of small bowel bacterial colonization in most patients and overgrowth in a proportion, which responds to antibiotics4. In fact, frequent occurrence of small bowel bacterial colonization, overgrowth and predictable response to treatment with antibiotics might suggest that the name TS or tropical malabsorption is a misnomer4. It should rather be considered as a condition associated with small intestinal bacterial overgrowth (SIBO) and colonization in the tropics in absence of an anatomical cause.” I included that explanation because of the possible link between TS and SIBO.

Thank you so much for your reply! I still have hope that I can heal on a plant-based diet!

Thea

Joseph: As someone who has never heard of SIBO before, I really appreciate that you took the time to explain a little about it in your post. Your post was really helpful to me.

Jody: Good luck to you. I know nothing about your condition, but it sounds tough. And it sounds to me that you have a very good chance of being able to do something about it on a plant based diet – or at least that there is no reason to believe that you would be better off on an animal based diet. (Of course, that is coming from someone who knows nothing about it…) Keep us posted. I bet you will figure it out. You sound motivated.

Jody

Thank you so much, Thea! I really appreciate the kind words.

elsie blanche

How about your fruit intake? Have you been instructed to cut back on high FODMAP fruits? For me, I think the SIBO issue is more so that I am taking in too much fiber. I think that we all have different gut environments/bacterial compositions, and too much fiber for me (and some others) can actually lead to overgrowth of good bacteria. I find when I go low fiber, way lower for a day or two, I have so much more energy it is amazing. I’ve been told by my GI specialist that this is a result of the opportunistic bacteria (both good and bad baceria in GI tract) having less “food” to feed upon, thus they are becoming weaker and stealing less of my nutrients. It really is a drain, the whole thing, because as a vegan I find it close to impossible to get my calories while cutting back on fiber. And I don’t want to gobble down coconut oil or the fatty calories to avoid this, since fats can also throw off the gut health. But it has been made clear to me that the bacteria are basically stealing my nutrients when I eat. Is this true? I can’t say for sure but like I said, much better energy and SIBO issues the less fiber I take in. Beans seem to be the most draining for me, as well as certain fruits that are either FODMAP, HIGH IN FIBER, or too quick digesting. What’s your experience on fasting? Also, keep in mind that SIBO depletes B12. B12 is fuel for SIBO, I am guessing. And it makes me wonder (this has been my experience) that feeding the gut such high dose B12 supplements might actually make the SIBO issue far worse. We’re adding jet-fuel to these bacteria.

Jeannie Danford

Oxalates and Plants per Dr. McDougal

Oxalates in plants are solidly complexed (usually with calcium) and cannot be absorbed into the body – unless the diet is high in fat. Then the fat forms soap complexes with the calcium and releases the oxalate for absorption and contributes to kidney stones.

The following text and these references to oxalate are from my McDougall’s Medicine—A Challenging Second Opinion book:

Eating meats also increases the amount of oxalate in the urine. Oxalate is the second mineral component in the most common form of kidney stone in this country. The increase in oxalate may result from an increase in absorption from the intestine or from an increased production of it in the body by way of the metabolic breakdown of certain amino acids present in great amounts in meat proteins.66

Even though plant foods, especially green leafy vegetables, are high in oxalates, in a normal person the oxalates are poorly absorbed, because in the intestine almost all of this substance is in the insoluble form of calcium oxalate.67 Fats from meat or any other source will assist the absorption of oxalates by forming so-called “soap complexes” with the calcium found in the calcium oxalate present in foods. When the calcium is combined with fats, the oxalate is freed for absorption.67

High concentrations of oxalate in the urine and frequent formation of kidney stones occur in people who have diseases of the small intestine such as Crohn’s disease. This is because of the large amounts of fat present in their intestinal contents caused by malabsorption of dietary fats resulting from their illness. When these patients are placed on a low-fat diet, the amount of oxalate in their urine decreases, and so does the likelihood of their forming kidney stones.68

66 Robertson W. The effect of high animal protein intake on the risk of calcium stone-formation in the urinary tract. Clin Sci 57:285, 1979.

Dr Gonzales
I respect Dr McDougall as much as I do Dr Greger, so this conflicting information about consumption of fats is always a concern to me. I know Dr Fuhrman position is the same as Dr Greger’s, small amount of fat with food helps to increase the uptake of nutrients. Dr McDougall believes it’s too problematic and high fat goods and should be avoided, that we should shoot for 10% fat, which is very hard to achieve unless you eliminate almost all foods that have significant amounts of fat, like nuts or avocados. It would be helpful if you or Dr Greger would please comment on this now or in the future and help clarify this position. If Dr McDougall is right, then it seems like you don’t want to have fats with veggies because it increases the risk of kidney stones, but then you might not uptake nutrients from the foods we eat.

As always, thanks!
Mark G.

Joseph Gonzales R.D.

Hi Mark. The studies above are from the 70’s. I have not read them in full. Perhaps the research has changed? I think Dr. McDougall focuses on treating very ill populations so perhaps his caution about fat is different for healthy populations? You can always ask him or his team. Dr. Forrester may be able to touch on this, too. Even if fat can boost oxalate absorption the 1974 study used 100 grams of fat per day! That is 900 calories coming from fat, which is a lot. Like 40-45% fat! Diet must be taken into account as a whole. Oh and I am not a doctor I am a registered dietitian, but thanks for the credential boost :) I hope this helps thanks for commenting.

mbglife

Thanks, for those thoughts, they’re very helpful. Putting the fat consumed in context of the entire diet might be part of the issue. I don’t frequent Dr McDougall’s website anymore because I’m more inline with the approach and the website here, so I won’t be asking him. But I asked here because he does recommend a maximum of 10% fat for everyone, period. And he believes in starch based diet and recommends potatoes, which Dr Greger doesn’t find much value in potatoes. The starch/potato difference came up among a few other readers who commented here recently. Maybe there’s a way for Dr Greger to help explain the difference in philosophies, maybe the answer is just in all the studies he reports on or maybe there’s just more that needs to be learned before we’ll know who’s more correct on some points.

Also, thanks for clarification on your title. So, is it not correct to address you as Dr. Gonzales? If not, what’s the correct or your preferred title when we address comments to you?

“It’s generally accepted that carbohydrate fermentation—the fiber and resistant starches that reach our colon—results in beneficial effects for the host because of the generation of short chain fatty acids like butyrate, whereas protein fermentation is considered detrimental for us. Protein fermentation mainly occurs in the lower end of colon, when carbohydrates get depleted and results in the production of potentially toxic metabolites. Perhaps that’s why we see more colorectal cancer and ulcerative colitis lower down, because that’s where the protein is putrefying. The simplest strategy to reduce the degree of potentially harmful compounds by protein fermentation is probably a reduction of dietary protein intake.

But, the accumulation of these harmful byproducts of protein metabolism may be attenuated by the fermentation of undigested plant matter. This study showed that if you give people foods containing resistant starch—starch resistant to small intestine digestion so it can feed our good bacteria down in our colon, foods such as cooked beans, peas, lentils, raw oatmeal, and cold pasta—you can block the accumulation of potentially harmful byproducts of protein metabolism. The more starch ended up in the stool, the less ammonia, for example.”

He is just a little more positive about fat from whole food plant sources than McDougall is. He is not positive at all about fat from animal sources or processed fats. He is not against any whole plant food source of starch, which is important to McDougall.

mbglife

Daniel, thanks for your thorough reply. It’s a fantastic post. I knew that Dr G likes purple and sweet potatoes (although sweet potato not being a potato), as well as some of the other basic distinctions/agreements between them on starch. I guess my biggest confusion is just on the fats. But regardless, your post is a great reminder and summary of information, especially your easy to understand explanation on protein metabolization, gut fermentation and which foods are best. Thanks, for taking the time to put it together and post it. Beautifully done.

BTW, I’ve recently discovered by accident that I could just soak rolled oat with water for a bit and eat them without any discomfort (I just wasn’t sure what would happen). I later learned that it’s really good for one’s health gut biome. I was glad to see you had it on your list. Bananas on the green side (more starch, less sugar) are also supposed to be a great pre-biotic for the gut bacteria.

Mark G

Wade Patton

Dr. Greger tends to align himself with the facts as he understands them. He has stated that he has no “position” but to report the information such that we can make our own -informed- decisions. The facts and findings of today may not be correct next week, and he’ll revise his works. Of course he is up against billions of dollars of advertising and influence, so share and learn and be as healthy as you choose.

David J

In Dr. Fuhrman’s recent book The End of Heart Disease he criticizes very low fat vegan diets that avoid or highly restrict nuts/seeds for those who are not overweight and have no obvious heart disease. His conclusion is that nuts/seeds are highly health-promoting, assuming one has no weight issues. He does, though, naturally exclude extracted oils. I recommend reading that book for his latest views. So I am still perplexed by this disagreement, but follow the Fuhrman line since I am an “underweight” vegan.

Joseph Gonzales R.D.

Joseph is fine ;-) Thanks, Mark G!

Thea

OH. I hadn’t seen this response when I posted above. That also helps to put things into perspective.

guest

He also says to avoid vitamin D supplements. Says they are harmful. Thoughts?

Jeannie: This was super interesting. Thanks for posting this. If true, it explains how someone could eat a plant based diet and still get stones (I originally wrote “stoned” by accident – which is actually funny…) – by having too much fat in addition to the whole plants (or too many whole plants which are primarily fat?). It’s yet one more reason to consider a lower fat diet as healthier compared to higher fat – regardless of where the fat comes from or what type it is. (Assuming I am understanding your post correctly.)

I know that I still eat way too much fat. Your post gives me something to think about personally. Thanks!

gunter73

“The number one risk factor for kidney stones is not drinking enough water” ..why is it so difficult to implement something so simple? If we do eat a lot of protein we need more water, we don’t necessarily have to cut back on our protein..simple. Check out Dr Mercola’s article for an alternative viewpoint on this matter http://articles.mercola.com/sites/articles/archive/2009/06/23/who-knew-preventing-kidney-stones-was-this-easy.aspx he is especially good on the sugar issue, which Dr Gregor did not address.
“A diet high in sugar
can set you up for stones, since sugar upsets the mineral relationships
in your body by interfering with calcium and magnesium absorption. Not
only does sugar and high fructose corn syrup lead to obesity and
diabetes, but also the current over-the-top consumption of these
unhealthy sugars by children is a large factor in why children as young
as age 5 or 6 are now turning up with kidney stones.”

Charzie

Before going WFPB I used to pass a calcium oxalate stone every few years, not a ritual I was happy about. I consumed a pretty huge volume of water after the first one, which is no doubt beneficial, but didn’t seem to stop them. Moving to FL where our water smells and tastes like sulfur, even “softened” water was putrid, so we opted for an RO system with a higher alkaline PH, which did seem to help for whatever reason, too. I consume plenty of foods with oxalates now, including some wild plants I forage, which may be even higher than market veggies, and all seems well. Hope I didn’t jinx myself!

Mac

Wow, what an incredible site for health and
nutritional information, thanks for sharing!

sisq

A lot of information at this site on this topic http://veganhealth.org/articles/oxalate. As noted at that link and others places, calcium in the diet can apparently bind oxalate so it passes through without being absorbed. I’ve seen references to putting calcium citrate supplements in green smoothies to tie up the oxalate . . .and also taking vitamin k2 (or if you can stand to eat it, natto) to help assure any extra calcium that is absorbed goes to the bones and not to soft tissues. Would be interested in hearing what Joseph or Dr. Greger or others think of this – is calcium supplementation eaten at the same time as the high oxalate food, and especially with K2 as well, possibly helpful for those of us eating a high oxalate diet as an added precaution?

vegank

The article below warns about drinking too much Iced Tea, because people normally drink larger quantities of Iced Tea than hot tea,
and it contains oxalate. How many cups of hot tea (with unsweetened almond milk)per day is ok to consume ?
I’m a Tea drinker and was hoping that 3 – 5 cups per day would be ok. There is no family pattern of forming kidney stones easily.

Taking aminos before bed can increase muscle mass/strength….”Overall muscle strength in the protein-before-bed group was twice that in the placebo group. The same was true for muscle mass. The protein guys had developed almost two times more muscle mass that the placebo group. As for muscle fiber content, the protein group had increased more than twice the amount of type II muscle fiber size than the men taking the placebo.”.

Not pushing supplementation per se….just the uric acid and other waste products vs protein source issues.

baggman744

“Whey and soy proteins – only 18% or less of their content is utilized by the body with 83% leaving as waste…” Curious, where did you read that?

Ding

Coconut water makes kidney stones fly right outta you.

Carmen

Aren’t kidney stones caused by too much calcium and not enough Mg in the diet?

FruitedDragon

How do I get my dad to stop eating meat? I’ve given him this website, individual videos and have shown him joe much energy I have and gown I never ever get sick.

Thea

FruitedDragon: It sounds like you are being a good role model and that is definitely part of a strategy that can help. I have some additional suggestions for you, but I would also caution the following: No matter how much it hurts to see our loved ones making serious mistakes, you can’t force them to change. And frustratingly, the harder your try, the less likely you are to find success. It is a basic human (mammal?) characteristic to resist pressure.

Having said that, you might try cooking some fabulous whole plant food meals for your dad. I think sometimes resistance to healthy eating comes because the person is worried that they won’t get to eat tasty and satisfying food any more. Subtly show that that isn’t true (no need to point it out) by simply preparing lots of good food. Also, you might try using some transition foods, such as fake meats or try soy curls, which may not be 100% healthy, but which can really help people make the transition from omnivore to whole food plant based eating.

Along those lines, you could offer to take your dad out to dinner at an all vegan place if there happens to be any where you live (and if you live near your dad). Then you don’t have to convince your dad to pick certain menu items – just to go to that restaurant to begin with. And hopefully the food will be very good and satisfying and be one more bit of convincing.

Also, while I think the daily videos on this website are simply awesome, I don’t think a few daily videos will do much to convince someone to change, because they don’t present the bigger picture. For that, you need your dad to watch the movie Forks Over Knives and then throw in the yearly summary videos on this site.

It’s unlikely that your dad will want to invest that sort of time. So, you might want to offer some quid pro quo. Has your dad been after you to do something that you haven’t been so excited about doing? (Some chore or help around the house? Going on a date with someone? I don’t know.) Just spending some quality time together? Maybe you could offer an exchange where your dad agrees to watch some full length movies with you and you agree to ____.

My belief is that people rarely change in a moment in a vacuum. They may make a decision to change their diet on day X in reaction to news or information Y, but I’m guessing that there were probably many experiences prior to day X which made the person open to information Y (“the straw that broke the camel’s back”) when it came along. If you can provide those little experiences without pressure along the way, you hopefully increase your chances of your dad making such a life change in the future.

I hope those ideas helped. Best of luck.

Rosemary Guy

just had a veg friend with kidney stones……..it is still a high protein and fat diet plus msg and processed foods

Sriram

Does vitamin k2 help prevent stones and calcification of arteries? What are the best sources for k2? According to Dr. mercola k1 to k2 conversing us boot sufficient.

Alex

web admin: there are both ‘oxalate’ and ‘oxalates’ topics. You probably want just one.

Ed

What about oxalates in veggies and fruits….Spinach and Strawberry’s are the number ones that can cause stones….i use to eat strawberries allot until i got a kidney stone….

Looking at the bigger picture, doctors and hospitals don’t like diet solutions because there is no profit in it for. Their profit comes from drugs & surgeries. However Insurance companies benefit from spreading the dietary solution because it cuts their expenses. Vegans should target insurance companies who financially will benefit from dietary solutions to diseases to force Doctors and Hospitals to recommend dietary changes first or not get reimbursed for useless drugs & surgeries.

Tan

Great points.

Midnight Luck

there are many many references to putting a piece of lemon in your smoothie, drinking (fresh) real lemon squeezed into your water, having a significant impact on breaking down Kidney stones, ESPECIALLY in those who eat meat. The makeup and the acidic nature of the lemon itself seems to have an incredible ability to stop Kidney stones, or break them down into less painful rocks in your tube.

The herb Chanca Piedra can be used in treating oxalate stones which form not just in your kidneys but virtually every tissue in your body-OUCH!. Another formula called ‘stonebreaker’ is also available.
According the Dr. Andreas Kalcker, these stones are from parasites. Parasites produce oxalates as well as other drug like substances which can cause anxiety, depression, constipation, sugar cravings, etc…….. Parasites are very common, unfortunately parasitology was removed from the medical school curriculum years ago in America so your physician is not aware that this may very well be the cause of your stones, gallbladder and kidney, etc. With more people having indoor pets (you worm them, why not yourself?) We are eating foods from all over the world, and travel to 3rd world countries is more and more common therefore, we are all being exposed. It’s a huge problem.

Annette Lockett

Thank-you very much for this video and all of your other very informative videos! My husband just had a 9mm kidney stone and gets them every 14 months or so. We have been eating alto of wild salmon and cod instead of chicken and red meat thinking it a better choice if we are not vegans.

joe

I feel Dr Greger has an agenda and wouldn’t present studies that show the opposite. What about those vegans that eat spinach, nuts and beans and also get stones?!?! If the doctor got a stone would he share it here? Probably not

Mireille

For animal protein’s effects on kidney stones, are they any studies that have attempted to distinguish between animals fed on grass and animal fed on grains (soy, corn .. ) Would it makes a difference ?

gust

How about spinach /chard

Joseph Gonzales R.D.

Question asked by CC I am reposting:

You mention oxalates in other videos. But a vegan friend of mine has found that many of the veggies that are great sources of calcium are also high in oxalates. I understand they can affect kidney stones and the gall bladder. Any other effects? Possible subject: “How should vegans get enough calcium while avoiding oxalates”. Can they affect uric acid? Generally, “what are the hazards of oxalic acid/oxalates?” At least add both “oxalic acid” and “oxalates” to your list of topics.

Really sad to learn that turmeric is bad for oxalates. I take it for pain. Know any natural alternatives? Or alternatives to cinnamon for blood sugar?

I was asking for a story about oxalates in general. What are they? Why they are problematic? Are they a problem for other than kidney stones? For those with diabetes? With gout? Other conditions? Is there only a limited number of conditions for which oxalates are a problem or should they be kept to a minimum no matter what one’s condition? Specifically, if oxalates are a concern to an individual AND if one is older and trying to avoid dairy because of the information about how milk interferes with calcium absorption, how can one get a lot of calcium without having to eat a huge amount of the veggies which have lower calcium content but are oxalates-free? Here is a link to a chart that makes the dilemma clearer:http://veganhealth.org/articles/ca_ox.

Thanks for whatever attention you can bring to this.

alphaa10

A friend reports his urinalysis came back with findings of calcium oxylate crystals. Having only recently embraced the vegetarian approach (with weekly lapses), the friend is not a vegetarian (completely) but no longer a heavy meat-eater, either.

If the cause is dietary, the friend suspects the oxylates come from the heavy increase of plant food in his diet, especially since the vegetables in his diet are known for creating oxylates. Is this presumption on the right track?

macrumpton

I have been a vegetarian for 20 years and I just passed a 3mm stone and a cat scan revealed a second 6mm stone. I used to eat a lot of cheese and eggs, and not a lot of fiber, and have since become vegan, eating lots of greens and fresh vegies. Hopefully that will help.
Anyone who has passed a kidney stone has no desire to repeat the experience ever.

Hello, my dad had undergone prostate laser treatment for BPH. At the same time, I had convinced him to try a plant-based diet. He was 80- 90% plant-based for a month. At his follow-up appointment for BPH, his urinalysis showed kidney stone formation. He was given Potassium citrate and Uloric to dissolve the kidney stones. For the 1 month that he was eating mostly plant-based food, he ate a lot of green leafy vegetables. Could that be the reason for the kidney stones? Is there a maximum amount of green leafy vegetables in a day? Thank you.

Joan E, RD-NF Volunteer

That is a great question!! One question would be, what kind of stone was it..In all likelyhood it was a calcium stone..but if not, there could be other factors at play. How is his water intake? Is he drinking enough fluids? Here in this video Dr. Greger goes into more detail regarding treating kidney stones http://nutritionfacts.org/video/how-to-treat-kidney-stones-with-diet/. Maybe if your dad could use Dr. Greger’s daily dozen as a guide to balance the types and quantities of plant based foods he is eating.. that might help.

docbeccy

Hi Eme, I am one of the site moderators. If possible, obtaining the stone once it is passed is very helpful to determine the composition of the stone and if a special diet is needed or not. Spinach, beets, chard, sweet potatoes and tea are very rich in oxylates which make up the most common stones. Other triggers can be high amounts of vitamin C – also found in these same foods or in a supplement. Like most things, increasing gradually and flushing the kidneys with large amounts of plain water is usually the best. Kidney stones are one of the most painful things a person can endure. I hope he’s better now and will not avoid healthy foods in the future but be a bit more judicious in his selections and make sure there’s a good mixture along with lots of water.

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